Device for performing and verifying a therapeutic treatment and corresponding computer program and control method

ABSTRACT

The invention relates to a device for performing and verifying therapeutic radiation. An x-ray beam ( 4 ) is arranged across from a target volume ( 3 ) of the beam source ( 11 ) for the high-energy beam ( 1 ) in such a way that the beams ( 1, 4 ) run in essentially opposite directions ( 5, 6 ). The invention also relates to a computer program and a control method for operating said device. The inventive device makes it possible to exactly verify areas ( 16, 16′, 16 ″) that are subjected to different levels of radiation, the entire anatomy of the target volume ( 3 ), and the surroundings thereof in addition to the contour of the therapy beam ( 1 ). The x-ray beam ( 4 ) detects the anatomy and position of the patient ( 21 ) within the range of the target volume ( 3 ) before the high-energy beam ( 1 ) is applied and the shape of the applied high-energy beam ( 1 ) is then detected and areas ( 16, 16′, 16 ″) that are subjected to different levels of radiation as well as at least one partial segment of the target volume ( 3 ) during the emission breaks of the high-energy beam ( 1 ). The detected data is used for correcting the treatment plan.

This application is the national stage of PCT/EP02/02693 filed on Mar.12, 2002.

BACKGROUND OF THE INVENTION

The invention concerns a device for performing and verifying therapeuticradiation, comprising a radiation source for a high-energy beam and ameans for modulation of the high-energy beam on the gantry of anirradiation device, wherein for verification, an X-ray beam is disposedacross from a radiation source for high energy beams and opposite atarget volume of the radiation source for those high-energy beams suchthat the rays extend substantially oppositely to each other, and with amedium for detecting the X-ray beam disposed, relative to its radiationdirection, behind the target volume and a medium for detecting thehigh-energy beam disposed, relative to the direction of this ray, beforethe target volume. The invention also concerns a computer program and acontrol method for operating this device.

A device of this type is disclosed in U.S. Pat. No. 5,233,990. In thisdevice, the therapeutic beam and the X-ray beam are imaged on a screen,to permit determination as to whether or not the delimitation of thetherapeutic ray by shielding blocks corresponds with the imaged X-rayimage of the target volume. This document also discloses a correspondingmethod for controlling this device and mentions the possibility of usinga computer program. This device only permits comparison of the outercontours of the therapeutic ray with the outer contours of the targetvolume. Spatial detection, detection of the treatment intensity ofregions to be irradiated with different intensities and detection of theanatomy of the irradiation surroundings are not possible. The intensityand the surroundings, however, provide important information ifstructures with low contrast, such as e.g. a tumor and endangeredorgans, are close to each other. This requires exact verification thatthe treatment zone corresponds with the position and anatomy of thetarget volume while avoiding critical target volume surroundings.

It is therefore the underlying purpose of the invention to provideradiation treatment which, in addition to the contour of the therapeuticray, also permits exact verification of regions of various radiationintensities and of the entire three-dimensional anatomy of the targetvolume and its surroundings, in particular, including borderingendangered organs.

SUMMARY OF THE INVENTION

This object is achieved with a device of the above-mentioned type, inthat the medium is designed for detecting regions of various radiationdoses of the high-energy beam, with a controller being connected to themedia for detecting the radiation, to the means for modulation of thehigh-energy beam, to a drive for adjusting the position of the patienttable, and to the radiation sources, wherein the controller isprogrammed with a treatment plan and designed to control the gantry andthe above-mentioned elements in such a manner that

-   -   a) before application of the high-energy beam, the anatomy and        position of the patient in the region of the target volume are        spatially detected by the X-ray beam by directing same onto this        region from various directions,    -   b) the detected anatomy and position of the patient are compared        with the treatment plan and the patient position and/or the        treatment plan are corrected, if necessary,    -   c) the high-energy beam is applied from a first direction and        thereby detected with respect to its shape and regions of        varying radiation doses,    -   d) at least one partial region of the target volume including        its immediate vicinity is detected by the X-ray beam during a        transmitting break of the high-energy beam,    -   e) the x-ray recording is compared with the detected, applied        high-energy beam and the treatment plan is corrected, if        necessary,    -   f) the steps c), d), and e) are repeated until the irradiation        prescribed by the treatment plan for the first irradiation        direction is achieved,    -   g) steps c) through f) are repeated for all irradiation        directions provided in the treatment plan. The inventive        computer program is designed to enable control of the device to        carry out the above-mentioned functions. It may be stored in a        permanent storage location of the controller or be made        available for control through a data carrier or online. The        control method also serves for operation of the inventive        device.

The inventive device and the inventive computer program and controlmethod permit basing the performance and verification of a therapeuticradiation treatment plan through determination of irradiations inthree-dimensional space.

In a first step, the X-ray detects whether the patient is positioned inaccordance with this three-dimensional plan, wherein the position aswell as the instantaneous anatomy of the patient can be detected,examined and corrected through detection from different directions usingthe X-ray beam. In case of substantial variations, it is, of course,also possible to restart treatment at a later point in time after suchcorrection.

In the subsequent processing steps, transmitting breaks in thehigh-energy beam—which are always present in pulsed beams—are utilizedto examine the above-mentioned features and to perform continuouscorrection and examination within intervals which are sufficiently shortthat even short-term anatomic changes, caused e.g. by the heart beat andbreathing or muscle flexations, can be taken into consideration. Thisexamination is performed many times for each individual treatmentdirection of the therapeutic beam such that erroneous irradiation can belargely excluded.

For this examination, the invention provides that at least one partialregion of the target volume, including its immediate vicinity, isdetected by the X-ray beam during the transmitting breaks of thetherapeutic beam. To be able to effect correction as quickly aspossible, i.e. even during the treatment cycle immediately following thebreak, only a critical region may be detected, verified, and corrected.Such a critical region could e.g. be a tumor edge which borders on anendangered region such as the spinal cord. In this case, the region ofthe tumor edge and the edge of the spinal cord must be examined andcorrected with particular care and accuracy.

The varying radiation doses for different regions of the target volumeare, in particular, also detected and compared with the current positionand anatomy and, if necessary, the treatment plan is corrected inthree-dimensional space. This examination may also include the regionaround the target volume which is compared with the treatment plan andis constantly taken into consideration for verification and correction.In particular, the entire treatment volume must be observed i.e. alltissue penetrated by the rays. The endangered organs must be taken intoconsideration to keep their exposure below a defined radiation dose.This radiation dose and monitoring of the surroundings is, inparticular, important in the vicinity of vital organs, the irradiationof which must be minimized.

It is essential for the invention that these examinations andcorrections are based on the three-dimensional information detected inthe first step, thereby providing much more accuracy compared to purelytwo-dimensional comparison proposed by the above-mentioned prior art.

The following further developments concern the inventive device, thecomputer program and the control method for operating the invention.These are preferably designed such that permanent verification is basedon three-dimensional detection of the region of the target volume inreal time. The term “real time” means that the region of the targetvolume is detected in three dimensions not only before treatment butalso during treatment. This is possible in that the X-ray beam isdirected, during transmitting breaks, onto at least one partial regionof the target volume including its immediate vicinity from differentdirections, but within a sufficiently small region that it issubstantially still opposite to the direction of radiation of thehigh-energy beam to also detect, via data collected from variousdirections, the above-mentioned detection region in three dimensions andtake it into consideration for verification in real time.

These different directions can be determined and technically realized indifferent ways. In one embodiment, the radiation source is designed suchthat the X-ray beam describes a circular motion in one plane which isdisposed around an axis extending through the target volume and towardsthe radiation source of the high-energy beam. To be able to process thisdata, the corresponding control method and a computer program arerequired which are designed for evaluation of the X-ray acquisitiondata. The circular motion may be exercised by a corresponding mechanicaldevice, e.g. using a rotary disc.

As mentioned above, it is of particular importance that the shape andposition of endangered organs is taken into consideration forverification and correction of the modulation of the high-energy beam.The controller, the method and the computer program for carrying out thecontrol must be designed accordingly. Towards this end, the inventionprovides particular advantages compared to conventional devices andmethods, since spatial detection and verification considerably reducesthe danger of substantial damage due to changes in position and anatomy.To be able to perform the above-mentioned verification in minimum timethereby taking into consideration a three-dimensional instantaneousrecording, the X-ray beam can detect a partial region of the targetvolume including a bordering region of an endangered organ during thetransmitting breaks in the high-energy beam, and this detection is takeninto consideration for verification in real time. This limits theprocessed data to the critical region, considerably reducing its amountwhile still providing continuous exact examination in three-dimensionalspace where required.

A protocol about the applied radiation, preferably in three-dimensionalspace, and/or a protocol about the corrections of the treatment plan forthe performed application of radiation are advantageously produced.

The above-mentioned features can be realized in the form of a device, acomputer program or a control method. The computer program is, ofcourse, only one preferred embodiment of a machine control sequencewhich is designed to be performed mechanically by the controller. Itcould also be designed as hardware or be carried out mechanically inanother manner.

In an advantageous further development of the device, both media fordetecting the high-energy beam and for detecting the X-ray beam aredesigned as one common medium. In this manner, one detection medium isomitted and the overall number of devices is reduced. Association of thetwo detections is also simplified. The individual detection elements canthereby also be used for detecting both beams by e.g. detecting theX-ray beam directly on the surface and the therapeutic beam duringpenetration through the medium. The medium must consist of a materialwhich is not damaged by the energetic therapeutic beam. The medium maye.g. be an array of photo diodes, which consist of an amorphousmaterial, e.g. amorphous silicon or amorphous selenium. The beams cannotthereby destroy a lattice structure. The photo diodes should also bedisposed in a housing which minimally attenuates the high-energy beamsuch that processing is not subject to differences which would berelevant to the treatment. The photo diodes could e.g. be disposed in aplastic housing which would prevent any noticeable weakening orscattering of radiation.

The following discussion with reference to the drawing serves to explainthe invention.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 shows a schematic diagram of an embodiment of the inventivedevice;

FIG. 2 shows an inventive device during use; and

FIG. 3 shows an explanation of the principle of optimum radiation to beverified in accordance with the invention.

DESCRIPTION OF THE PREFERRED EMBODIMENT

FIG. 1 shows the principle of the invention using an embodiment of theinventive device. A high-energy beam 1 is generated by a radiationsource 11 and modulated by a means for beam modulation 2, e.g. amultileaf collimator, in accordance with the treatment plan, anddirected onto a target volume 3. This is generally a tumor of a patient21 who is lying on a patient table 19. In accordance with the invention,a medium 8 for detecting the high-energy modulated beam 1 with respectto its shape and regions 16, 16′, 16″ of different radiation doses (FIG.3) is disposed in the path of rays 9 between the means 2 for radiationmodulation and the patient 21, such that the shaping and intensitymodification of the device 2 for radiation modulation can be detectedand monitored. If the modulation of the ray 1 differs from its desiredvalue, switching off or correction-may follow.

A radiation source 10 for an X-ray beam 4 is disposed opposite to theradiation source 11 for the high-energy beam 1 such that a path of rays9 is generated, in which the direction 5 of the X-ray beam 4 issubstantially opposite to the direction 6 of the high-energy beam 1. TheX-ray beam 4 serves to detect the target volume 3 and the anatomy andposition of the patient 21 in the manner described above. A medium 12detects the X-ray beam 4 after its passage through the patient 21. Themedia 8 and 12 are suitably designed as medium 13 for detecting thehigh-energy beam 1 and the X-ray beam 4. Reference is made to theabove-mentioned embodiments with regard to suitable design.

The radiation sources 11 and 10 are arranged such that the therapeuticbeam 1 irradiates the target volume 3 and the X-ray beam 4 detects thetarget volume 3 and its surroundings which should also be taken intoconsideration for modulation of the therapeutic beam 1. For this reason,the X-ray beam 4 is more divergent than the therapeutic beam 1. TheX-ray beam 4 may, of course, be narrower than shown and must not detectthe entire patient 21.

If a detection medium 13 is provided, its surface must be dimensionedsuch that it detects the conically diverging rays 1 and 4 in theposition of the arrangement of the detecting medium 13.

The treatment is suitably carried out with the following steps:

In a first step of the verification procedure, a current computertomography data set of the patient 21 in the therapeutic situation isobtained directly before start of the radiation therapy using a computertomography system i.e. the X-ray beam 4 and a medium 12 or 13. Changesof the target region 3 and position errors of the patient 21 can bedirectly recognized such that the subsequent therapy can be matched withthis new data. The target region 3 and its surroundings are detectedseveral times from various directions 7 (see FIG. 3), wherein thesedirections 7 are obtained through rotation of the gantry 14 to variouspositions. Using the data obtained in this manner, a controller (FIG. 2)can produce a three-dimensional image of the target volume 3 and itssurroundings and compare it with a previously established, storedthree-dimensional treatment plan. The position of the patient 21 canthen be corrected e.g. through adjustment motions of the patient table19 (FIG. 2) or through correction of the treatment plan.

In a second step, the field shape and the intensity distribution of thetherapeutic beam 1 are measured and recorded during application of thetherapeutic radiation fields 24 (FIG. 3). Thereby and on the basis ofthe current computer tomography data set, the radiation dosedistribution 16, 16′, 16″ (FIG. 3) applied to the patient 21 can bereconstructed and verified online. In case of deviations, theirradiation can optionally be interrupted or continued withcorresponding corrections. The type and arrangement of the X-ray source10 and of the medium 13 for detecting the beams 1 and 4 permitmonitoring of the relative position of structures (target volume 3,regions 16, 16′, 16″ of the target volume 3 to be irradiated withdifferent doses, and endangered organs 17) with low contrast (softtissue contrast) in the therapeutic radiation field 24 and itssurrounding (FIG. 3) by means of the X-ray beam 4 during application ofthe individual therapeutic radiation fields 24 and performance ofimmediate and nearly simultaneous correction.

This requires continuous detection of the above-mentioned parameters,which is effected in accordance with the invention in the transmittingbreaks of the high-energy beam 1 using the X-ray beam 4 and the medium12 or 13 and can be directly taken into consideration for subsequentapplication. This detection is also included in the previously detectedthree-dimensional parameters to obtain exact verification andcorrection.

In an advantageous manner, the above-mentioned permanently taken“current recordings” of the target volume 3 detect three-dimensionalparameters during transmitting breaks in the high-energy beam 1. This ispossible by directing the X-ray beam 4 onto the target volume 3 fromdifferent directions during detection. In one embodiment, the radiationsource 10 for the X-ray beam 11 is designed such that it can describe acircular motion in one plane about an axis 28 extending through thetarget volume 3 towards the radiation source 11 of the high-energy beam1. This is not illustrated since the motion is very small and thedirections 5, 6 of the beams 1, 4 remain substantially opposite to eachother. Of course, the controller 15 (FIG. 2) must be designed such thatit establishes a three-dimensional representation of the region of thetarget volume using the data of the X-ray recordings along this circularmotion to use same for verification.

This circular motion, which is performed mostly in a small region, maybe effected e.g. mechanically through eccentric arrangement of theradiation source 10 of the X-ray beam 4 on a rotary disc.

The above-mentioned “current recordings” can be limited to a criticalregion e.g. to a region where the tumor borders on an endangered organ.

FIG. 2 shows an inventive device during use. This conventionalconstruction of a radiation device 18 comprises a radiation source 11for the therapeutic beam 1, a patient table 19 and a means 2 forradiation modulation to direct the medically indicated radiation onto atarget volume 3, e.g. onto the head 20 of a patient 21 such that a tumoris maximally damaged and the surrounding tissue is protected to amaximum degree. Towards this end, a frame (gantry) 14 is provided whichcan surround the patient 21 from all sides. The gantry 14 contains theradiation source 11 for the therapeutic beam 1, with the high-energyradiation 1 being generated e.g. by a linear accelerator 22. Theradiation source 10 for the X-ray beam 4 is disposed on the gantry 14opposite to the radiation source 11, as previously described in FIG. 1.In this connection, reference is made to the above description, whereinidentical reference numerals refer to components having identicalfunctions.

The gantry 14 can be rotated about a horizontal axis of rotation 23,wherein the beams 1 and 4 are directed onto the target volume 3 or itssurroundings. The target volume 3 is in the isocenter of the beams 1 and4, wherein the radiation sources 11 and 10 and a means 2 for radiationmodulation circulate around the axis 23 of the patient 21 duringrotation of the gantry 14. At the same time, the treatment table 19 maybe displaced or rotated to provide exact adjustment of the setting ofthe radiation of the therapeutic beam 1 onto the target volume 3 of thepatient 21. The position of the patient 21 can thereby be corrected suchthat he/she is positioned in accordance with the treatment plan.

Through rotation of the gantry, the target volume 3 experiencesmaximized irradiation from the various irradiation directions 7 (FIG.3), while the surrounding tissue is protected to a maximum extent, sinceit is exposed to the high-energy beams 1 only for a short time.Moreover, certain areas of the body, such as e.g. the spinal cord orother endangered organs 17, must be completely protected from thehigh-energy radiation 1 and are largely excluded by the design of thetherapeutic radiation fields 24 from the various directions 7 (FIG. 3).

The position and the profile of the target volume 3 and the position ofendangered organs 17 or of areas 16, 16′, 16″ which are provided fordifferent radiation doses are detected by the medium 13 in threedimensions using the X-ray beam 4. At the same time, the actual state ofthe modelled therapeutic beam 1 is also detected and optionallycorrected as described above. This data is processed such that thecollimator 2 forms a corresponding collimator opening, with which theexact shape of the target volume 3 can be irradiated with the desiredradiation dose distribution 16, 16′, 16″ (FIG. 3) through the inventivedetection and verification. Using collimator 2, the radiation dosedistribution 16, 16′, 16″ is obtained through application of one or moretherapeutic radiation fields 24 of various duration from severaldirections 7.

To be able to obtain any setting, a controller 15 is provided which maybe a specially designed or universally usable computer. The controller15 is provided with the treatment plan and is connected to media 8 and12 for recording the data to be processed and for control of theabove-mentioned processing, to the medium 13 for detecting the beams 1and 4, to the means 2 for modulation of the high-energy beam 1, to adrive for setting the position of the patient table 19 and to radiationsources 10 and 11 and to a drive and a position detection means for thegantry 14. It is operated in correspondence with the inventive controlmethod, e.g. using the inventive computer program. The radiation source11 and the means 2 for radiation modulation, the gantry 14, andoptionally also the patient table 21 are controlled on the basis of theirradiation plan and the above-described repeated verification. Themeans 2 may be a collimator or a scanner. The therapeutic radiationfields 24 to be irradiated are defined by the collimator or generatedthrough scanning of a therapeutic beam 1.

FIG. 3 illustrates the principle of tumor irradiation, wherein amedically indicated high-energy radiation 1 is applied from differentdirections 7. For optimum irradiation of a target volume 3, e.g. a tumoras mentioned above, and maximum protection of the bordering tissue,various therapeutic radiation fields 24 are formed for each of thedifferent radiation directions 7. This is provided by the means 2 forradiation modulation which may be designed as a collimator or scanner.To assure that the target volume 3 to be irradiated receives therequired dose while endangered organs 17 are protected, the therapeuticradiation fields 24 may e.g. be formed as matrices 25 of individualfields 26 with different radiation doses. Other possibilities, such ascontinuous scanning, are also feasible. Such matrices 25 can bereproduced in almost any shape through leaf adjustments of a multi-leafcollimator, wherein thin leaves obtain an optimum fine reproduction ofthe therapeutic radiation fields 24. In addition to the example shown,several different therapeutic radiation fields 24 of different durationmay be applied to obtain regions 16, 16′, 16″ with different radiationdoses in an optimum manner. In this process, the inventive, nearlysimultaneous verification and correction takes place in theabove-described manner i.e. with repetitive verification which isfrequently performed for each radiation direction 7.

The figures represent only examples of the invention. The therapeuticradiation fields 24 can also be generated by a scanner instead of acollimator. The scanner then serves as means 2 for radiation modulationand the medium 8 or 13 must detect the scanned therapeutic radiationfields 24 such that the inventive verification and correction, includingoptional interruption of treatment, can be effected in an appropriatemanner. Other designs are also feasible, which utilize the basic idea ofthe invention.

LIST OF REFERENCE NUMERALS

-   1 high-energy modulated beam (therapeutic beam)-   2 means for beam modulation-   3 target volume-   4 X-ray beam-   5 direction of the X-ray beam-   6 direction of the high-energy beam-   7 different directions of detection and irradiation of the target    volume-   8 medium for detecting the high-energy modulated beam-   9 path of rays-   10 radiation source for X-ray beam-   11 radiation source for high-energy beam-   12 medium for detecting the X-ray beam-   13 medium for detecting the high-energy beam and X-ray beam-   14 gantry-   15 controller (computer)-   16,16,16″ regions of different radiation doses (radiation dose    distribution)-   17 endangered organs (e.g. spinal cord)-   18 radiation device-   19 patient table-   20 head-   21 patient-   22 linear accelerator-   23 axis of rotation of gantry-   24 therapeutic radiation fields-   25 matrices-   26 individual fields-   27 brain-   28 axis which extends through the target volume to the radiation    source of the high-energy beam

1. A device for performing and verifying therapeutic irradiation, thedevice having a radiation source for a high-energy beam and means formodulating the high-energy beam on a gantry of an irradiation device,wherein, for verification, a radiation source of an X-ray beam isdisposed on a side of a target volume opposite to the radiation sourcefor the high-energy beam such that a direction of the X-ray beam issubstantially opposite to a direction of the high-energy beam, wherein amedium for detecting the X-ray beam and for detecting the high-energybeam is disposed between the radiation source for the high-energy beamand the target volume, the medium being designed to detect regions ofdifferent radiation doses of the high-energy beam, the device alsohaving a controller connected to the medium for detecting thehigh-energy and X-ray beams, to the modulating means for the high-energybeam, to a drive for adjusting a position of a patient table, and to theradiation sources for the X-ray and high-energy beams, wherein thecontroller can be loaded with a treatment plan to control the device,the device comprising: means for detecting an anatomy and a position ofthe patient in a region of the target volume via the X-ray beam bydirecting the X-ray beam onto the region from various directions beforeapplication of the high-energy beam; means for comparing the detectedanatomy and position of the patient to the treatment plan and forcorrecting the patient position and/or treatment plan, if necessary;means for applying the high-energy beam from a radiation direction andfor detecting a shape and area of various radiation doses thereof; meansfor detecting at least one partial region of the target volume includingan immediate vicinity thereof using the X-ray beam during an irradiationpause of the high-energy beam; means for comparing an X-ray recordingwith a detected applied high-energy beam and for correcting thetreatment plan, if necessary; means for iterative repetition until aprocess prescribed by the treatment plan is completed for said radiationdirection; and means for repeatedly changing said radiation direction asprescribed by the treatment plan.
 2. The device of claim 1, furthercomprising means for directing the X-ray beam, during irradiation pausesof the high-energy beam, onto at least one partial region of the targetvolume, including an immediate vicinity thereof, from various directionsand within a region which is sufficiently small to remain substantiallyopposite to a direction of the high-energy beam in order to examine adetection region in three dimensions using data detected from variousdirections and for verification in real time.
 3. The device of claim 2,wherein the radiation source for the X-ray beam is designed to describea circular motion in a plane which is disposed about an axis extendingthrough the target volume towards the radiation source of thehigh-energy beam.
 4. The device of claim 1, wherein the controller isdesigned to consider a shape and position of endangered organs duringverification and correction of modulation of the high-energy beam. 5.The device of claim 1, wherein the X-ray beam can detect a partialregion of the target volume together with an adjacent region of anendangered organ during irradiation pauses of the high-energy beam forverification in real time.
 6. The device of claim 1, wherein thecontroller is structured to establish a protocol of applied radiation.7. The device of claim 6, wherein the controller is structured toestablish a protocol in three-dimensional space.
 8. The device of claim1, wherein the controller is structured to establish a protocolconcerning corrections of the treatment plan for performed irradiation.9. The device of claim 1, wherein the medium comprises a first mediumfor detecting the high-energy beam and a second medium for detecting theX-ray beam.
 10. The device of claim 9, wherein at least one of saidfirst medium and said second medium comprises an array of photo diodeswhich consist essentially of amorphous material.
 11. The device of claim10, wherein said photo diodes are disposed in a housing which onlyslightly attenuates the high-energy beam.
 12. A computer program forcontrolling a device for carrying out and verifying therapeuticirradiation using a high-energy beam, the high-energy beam beingmodulated by a means for radiation modulation, wherein, forverification, an X-ray beam is directed onto a target volume in adirection substantially opposite to that of the high-energy beam inorder to detect the target volume, and the X-ray beam, is detected,relative to its direction, behind the target volume to produce an imagethereof, wherein the high-energy beam is detected in front of the targetvolume, the program being structured to control the device using acontinuer executing the following steps: a) spatially detecting ananatomy and position of a patient in a region of the target volume viathe X-ray beam by directing same onto said region from variousdirections before application of the high-energy beam; b) comparing thedetected anatomy and position of the patient with a treatment plan andcorrecting the patient position and/or treatment plan if necessary; c)applying the high-energy beam from a first direction and detecting ashape and area of various radiation doses thereof; d) detecting at leastone partial region of the target volume, including a direct vicinitythereof, using the X-ray beam during an irradiation pause of thehigh-energy beam; e) comparing an X-ray recording extracted in step d)with detection of the applied high-energy beam extracted in step c) andcorrecting the treatment plan, if necessary; f) repeating steps c), d),and e) until an application prescribed by the treatment plan iscompleted for the first radiation direction; and g) repeating steps c)through f) for all radiation directions prescribed by the treatmentplan.
 13. The computer program of claim 12, wherein the program isdesigned to control the X-ray beam from different directions duringirradiation pauses of the high-energy beam, wherein these directionsmove within a range which is sufficiently small that the X-ray beamdirection is still substantially opposite to a direction of thehigh-energy beam and impinges on at least one partial region of thetarget volume including an immediate vicinity thereof for verificationin three dimensions and in real time using data detected from differentdirections.
 14. The computer program of claim 12, wherein data isobtained by causing a radiation source for the X-ray beam to describe acircular motion in a plane which is disposed about an axis extendingthrough the target volume and towards a radiation source of thehigh-energy beam.
 15. The computer program of claim 12, wherein theprogram is designed to analyse a shape and position of endangered organsfor verification and correction of modulation of the high-energy beam.16. The computer program of claim 12, wherein a partial region of thetarget volume, including a bordering region of an endangered organ, isdetected by the X-ray beam in irradiation pauses of the high-energy beamand taken into consideration for verification in real time.
 17. Thecomputer program of claim 12, wherein the program is structured toestablish a protocol concerning applied radiation.
 18. The computerprogram of claim 12, wherein the program is structured to establish aprotocol concerning corrections to the treatment plan for performedirradiation.
 19. A control method to operate a device for carrying outand verifying therapeutic irradiation using a high-energy beam modulatedby a means for radiation modulation, wherein, for verification, an X-raybeam is directed onto a target volume in a substantially oppositedirection with respect to that of the high-energy beam to detect thetarget volume, wherein the X-ray beam is detected behind the targetvolume to effect an image thereof and the high-energy beam is detectedin front of the target volume, the method comprising the followingsteps: a) spatially detecting an anatomy and position of the patient ina region of the target volume using the X-ray beam by directing sameonto said region from various directions and before application of thehigh-energy beam; b) comparing a detected anatomy and position of apatient with a treatment plan and correcting the patient position and/orthe treatment plan, if necessary; c) applying the high-energy beam froma first direction to detect a shape a thereof and regions of variousradiation dosage; d) detecting at least one partial region of the targetvolume, including its direct vicinity, using the X-ray beam and duringan irradiation pause of the high-energy beam; e) comparing an X-rayrecording of step d) with a detected applied high-energy beam of step c)to correct the treatment plan, if necessary; f) repeating steps c), d),and e) until an application prescribed by the treatment plan iscompleted for the first radiation direction; g) repeating steps c)through f) for all radiation directions prescribed by the treatmentplan.
 20. The control method of claim 19, wherein the X-ray beam isdirected, from different directions within a region which issufficiently small that it is still substantially opposite to adirection of the high-energy beam, onto at least one partial region ofthe target volume including an immediate vicinity thereof and duringirradiation pauses of the high-energy beam to detect parameters in threedimensions for verification in real time using data detected fromvarious directions.
 21. The control method of claim 20, wherein the datais obtained by causing a radiation source for the X-ray beam to describea circular motion in a plane which is disposed about an axis whichextends through the target volume and towards a radiation source for thehigh-energy beam.
 22. The control method of claim 19, wherein a shapeand position of endangered organs are taken into consideration forverification and correction of modulation of the high-energy beam. 23.The control of claim 19, wherein the X-ray beam can detect a partialregion of the target volume having a bordering region of an endangeredorgan during irradiation pauses of the high-energy beam for verificationin real time.
 24. The control method of claim 19, wherein a protocol isestablished of applied radiation.
 25. The control method of claim 19,wherein a protocol is established concerning corrections to thetreatment plan for performed radiation application.